Selke

What is the difference between an online and distance educational program? I saw both terms used in the first post of this thread and I'm confused - I use them interchangeably. Am I incorrect? Are they different? Thanks.

I'm not quite answering your question, but have you tried therapies other than opioid narcotics, such as physical therapy, acupuncture or acupressure, getting a trainer, swimming, yoga, anything like that? 60 vicodin in a month is quite a bit. Have you tried getting a second evaluation by a surgeon at a spine center that specializes in this kind of case? Maybe there is a problem caused by the surgery or maybe you did not heal properly. The restrictions you were given are pretty standard for anyone having had a spinal fusion, but may not be permanent. You do what you feel you are able to do. I suggest a second opinion by an experienced surgeon with revision surgeries at a major medical center, such as UCSF, Mayo, or NYU. And yes, nursing will exacerbate any back problems you have. There are threads here on how to tell employers one is on narcotics and not lose one's job. Nursing has one of the highest rates of back injuries of any occupation. Unless you want to go directly into an NP program, you might want to look at other allied health fields, such as occupational therapy, physical therapy, speech therapy, ultrasonographer, &c .... there is a demand for all of these.

I suggest you take a few undergraduate philosophy classes and at least one ethics course while you are completing your BSN. If your school has a department of religious studies, I suggest taking an introductory class or two. If your interest is still there, after getting your BSN, I suggest investigating the universities in your area that offer degrees in philosophy, ethics, or religious studies. There may be an interdisciplinary course of study you can take as well. Divinity schools are another option esp. if you are near a UU Div school. You generally do not have to be "churched" to enroll in div school -- many offer MA and PhDs, not just MDivs -- and the best ones offer allow students to create an interdisciplinary course of study, such as Univ of Chicago, Yale, Harvard, among others. (I did all this prior to nursing but I hate to say, this education is wasted if you are just a nurse -- you need a PhD and need to get where you can get published. Otherwise you wind up more educated than many nurses and managers and this can cause political problems.)

A recruiter told me this week that there is a drop in posted positions in some places like CA due to the severe budget shortfall ... if the state can't pay medicare/medicaid then the hospitals can't afford to pay RNs. I'm wondering how finances will impact enforcement of the staffing ratio law.

There are many midwives with MPH and/or DrPh degrees. Many want to get their MPH after finishing their MSN/CNM. It is a popular credential to have, for both those wanting to work in the US and overseas. Nurse midwifery, in part, arose out of maternal child public health issues in the early 20th century (see Judith Rooks's book on the history of nurse-midwifery in the US). Maternal child health is the bellweather of the health of an entire nation. You are already on a good path to become a midwife!

Not only will nursing courses NOT count towards medical school, you need to look carefully at the undergraduate science prereqs you are taking for nursing vs. medical school. There are usually different levels of difficulty of basic science courses (microbiology, chemistry, anatomy and physiology) offered to undergraduates, for example "science for liberal arts majors" type of classes, meant to fulfill undergraduate science requirements. These courses are often accepted for nursing school prereqs. BUT they will NOT be accepted for medical school. If you are unsure which career path you want to take, be sure you enroll in the "regular," hard science prereqs, which science majors take, which will be accepted by medical school admissions. You should speak with an admissions counselor at your college, maybe find a premed advisor, to discuss these things with, to make sure you enroll in the right courses. There are many positives nursing education and experience brings to medical education, e.g. good interpersonal skills, caring for the whole person, but there is no overlap in courses or work experience.

The way the OP phrases things, her speech patterns, strike me as a bit odd. I can't put my finger on it. Maybe English isn't her primary language? I suspect the OP has some codependency issues based on her perception of nursing, or a belief system that she needs to be devoted to selfless serving of others ... something just strikes me as a little weird in all this. These are just observations, they may be groundless ... nothing personal.

The Book of the Dead, the Bardo Thodol, the "liberation through hearing in the intermediate state", is a Tibetan Buddhist funerary text from the Tibetan Buddhist Nyingma tradition, again bringing up the hearing/voice meme. Here's the wikipedia entry: http://en.wikipedia.org/wiki/Tibetan_book_of_the_dead I like the translation by Chogyam Trungpa with the introduction by Francesca Freemantle, who gives a great introduction to the bardo and what does all this mean? These are difficult texts for Westerners -- even for Tibetans -- to understand. I found Tibetan Buddhism to provide a framework for understanding just these kinds of events we experience in health care -- who else besides monks and nurses even bring up the subject of the benefit of talking to the dying? (Thanks to the OP for posing the question!) You are close about the Siberian monks, shouldhavebeenanunRN -- Tibet is somewhat close to the Siberian steppes. Actually the indigenous religion to Siberia is shamanism, and Tibet also had its indigenous shamanistic tradition that predated the spread of Buddhism. Tibetan Buddhism incorporated much of this native Bon shamanism into its practices. Shamanism is another ancient religious tradition that acknowledges fluid boundaries between the worlds, in fact the shaman is the one who makes the journey between them, in order to get divine wisdom and gifts from the gods to give to the people of the community. Healers are frequently shamans in these societies -- midwives should be, not sure where they fit in. You can read Mircea Eliade's Shamanism, which was the seminal text on this for a long time. I think of modern Wicca as sort of a contemporary form of ancient shamanism. Sallie Tisdale is a Buddhist teacher and writer with published books on Buddhism and various other things. I recently found out that she is also an oncology nurse! (If it is the same Sallie Tisdale.) I was sort of surprised (authors must not make lots of money off their books), but not really ....

Hearing is the last sense to go ... when one leaves the body, one does not immediately "disappear" but lingers some time and observes what's going on. The Tibetan Book of the Dead gives an extraordinary account of the stages of dissolution of the self, and the words that the living can say (prayers) to help guide the soul out of this bardo (state between two worlds), to guide the soul (in the book they are referring to monks who are highly trained in meditation states) through the realms of the dead into the realm of their choosing (sort of). I think here, in our secular hospital, talking to the dead and sending good energy can serve somewhat the same purpose, to help the soul let go on its way ... if I was not working in women's health I have thought of working in home hospice. Birth is kind of the reverse process of dying, another form of bardo, in which the newly besouled human comes out of its mother into this world of impermanence and suffering. Newborns need to be talked to as much as the dead, and mothers instinctively do this. A baby hears and knows its mother's voice while in her womb. This helps ground them in this world. Terminations and stillbirths don't bother me because the "vibe" I get from these situations is it simply isn't the right time for this little being to be here now, it's a neutral situation, but is sad for the parents. I talk to these little ones too, if they are still around, and wish them well on their journey and their next embodiment. When a fetus is crashing and we are scrambling to save its life (usually in the OR) I can feel the presence of the angel and of death (will the angel breathe life into the baby, or will death cut the cord and claim it?) and it sends chills up and down me. Larger forces than we are at play here. Peggy Vincent, in "Babycatcher," has a section where her son explains what happens to the souls of babies that die ... I won't tell you what it is, go read the book; this is one very, very wise young man. There are many bardo states in life (think life transitions), and we all need reassurance and human contact, to hear a soothing voice to lead us through, when we are in the midst of them.

Sending you lots of luck! You'll do great!

Don't tell them anything at all about a custody battle or other personal issues. Just say a last minute family obligation came up that could not be rescheduled and leave it at that. Stay very professional and superficial. If the Admin "hears" that you have a lot of personal stuff going on that could negatively impact your education they may think twice about admitting you. I will say that personal family issues seem to be one huge cause of course difficulty and attrition (either through taking leave of absences, quitting, or getting kicked out of school for course failure) at Frontier. The advantage of being enrolled in a distance program as a someone who works and has family responsibilities, the flexibility to study on your own time, is also the disadvantage, in that without a brick and mortar building and a tight week by week timeline, it is VERY EASY to get behind VERY FAST. Family issues derail students more quickly than anything else. If you do get admitted, and if you do have these issues, you may consider going part time until they are resolved.

TV and the internets ....

n_g, I agree with your point. Many nurses have enough trouble funding graduate education and finding time to do it. Lengthening the program and making it more costly will not necessarily benefit them, improve the NP professions, or increase the # of NPs on the market or increase # of jobs. Look at the requirements for a DNP. It's not all clinical, like an MD!! I think you would be better off getting a PhD in Public Health (DrPH?), it is a recognizable degree, you acquire more higher level job skills, and you would have more job options. Meanwhile, the AMA continues to whittle away at the right of APRNs and CNMs to practice, malpractice insurance becomes more difficult to obtain and rising costs drive CNMs and others out of a job altogether and back into the ranks of staff RNs, hospitals and MDs continue to drop CNM and maybe NP privileges, and the reimbursement fight with insurers goes on and on without resolution ... we can't even get a federal law passed in Congress mandating equal reimbursement for CNMs for care. Given the big picture, this DNP seems pure vanity to me, sucking energy and time away from these other much more critical fronts. Just my 2 cents.

Most if not all Frontier students have to work through school from financial necessity so you are not alone. Many do work full time, although it works best to have flexibility with your job so you can cut down to part time or per diem or work fewer hours when you have exams and things due. I worked my way through as a travel nurse; there are others I've met who do this too. Working 3 12's is full time and gives you 4 days off a week to study. This seems to be what many students do. Some students luck out and have jobs, maybe on nights, where they are not too busy and can study. You want to be able to NOT WORK, however, if/when you get to level IV (clinicals). There are classes to complete believe it or not (I hear they are changing this requirement to have coursework completed prior to Level IV, although I'm not sure how this will work, i.e. add an extra term or what) and the students who have to work, do classes, and do clinical are dying from exhaustion. It is easier to work through levels I & II. So if you can save your money or take out loans for that last level, you will be better off.

I was a patient -- rather I was tortured -- as a teenager in 1971 in one of the last Scottish Rite Crippled Children's hospitals, which had those old wards with the old staffing system and horrifically poor pt care. It is a world unto itself, that has thankfully disappeared from the U.S. This particular hospital was torn down in the early 1980s and was forced to revamp its entire care system when the new one was built. There was maybe 1 or 2 RNs on the floor, LVNs and CNAs provided the care, for very sick kids. I was literally dying of several complications (massive wound infection, high temps, DIC) and did not get adequate treatment that if I was in the private hospital on the other side of town I would have been in the ICU. My family was deemed "low class" by the orthopedist which is why he funneled me into that hospital and not the private one. I have a copy of all my records and this is all documented. Documentation was abysmally poor and would not meet any current standards. I won't forget the metal bedpans, the forced enemas, the rude and rough CNAs, the awful smell of the sheets, the rock hard bed (agonizing after back surgery), the lack of PT/OT, horrible food, families only being able to visit 1 hour a day and could not bring food or treats in, the lack of adequate pain medication (I was told I would become an addict if I got enough morphine), the wound debridement in the room without anesthesia of any kind, the near death experience .... it just goes on and on. I cannot make this stuff up. I was so thin and sick my mother actually snuck in some food I liked a couple of times, and she is scared to buck authority. That was my adolescence. Those hospitals are a whole different world the rest of society knows nothing about. I'm not the only one with a horror story, either.

I'm very biased towards CA, esp. northern CA ... if I had to work as a staff nurse again I would move right back to the SFBA. I worked there through the implementing of the staffing ratios. What others said is true that RNs returned to work when it was perceived that now ratios are better and safer, plus salaries kept increasing. I returned to work as a travel nurse, from the central coast back up to Nor Cal, and the central coast/central valley struck me as very conservative areas compared to SFBA. BUT I think there is a "trickle down" effect of the ratio law: I observed conservative nurses (i.e., call the doctor "Doctor," play the gender roles of female nurse/male doctor, socially conservative) who formed unions and were actively beginning to stand up to management regarding pay, staffing issues, and breaks. This was a sight to behold. That said, there are hospitals (like the ones I'm thinking of in the previous paragraph) that did not follow staffing laws very well (2 RNs on nights for a packed L&D unit, for example). While these RNs were starting to stand up for themselves, they still weren't filling out ADO forms and otherwise raising hell with poor staffing, but instead grumbled about how "those travel nurses are sucking up all our money!" Then, many hospitals, even in the SFBA, do things to cut down on staff expenses like not having enough unit secretaries, eliminating all the CNAs and LPNs, things like that. They also tried to have LPNs relieve RNs for breaks and lunch. I think there are few legal repercussions for hospitals that do not follow the staffing ratios, and this is bad, because if there is no teeth, then hospitals will keep pushing back against it all they can. Although there are a few progressive hospitals out there, such as the one in Houston mentioned, that do staff very well, they are outliers. I hope every state nursing association will introduce minimum staffing laws into their legislatures. Nursing unions are taking off in previous so called "right to work states" which historically have ridden union organizers out on a rail and tarred and feathered them. (Of course I keep hoping for a populist revolt against the corporate masters that own our government and politicians, but I am not holding my breath for THAT to happen.)

But states require the MSN for licensure, NOT a DNP. They may not even accept a DNP for licensure without an MSN. So I do not understand how some nursing organization can mandate a DNP for entry into practice, unless I am missing something here. Who is going to help people pay for these DNPs? Some of us can barely afford to get our MSN as it is. Forget a DNP, that 's completely off the table for me. Might as well go to medical school -- med students seem to have access to much larger amounts of loan money than nursing students, and it might take as long to get a DNP as an MD, so go for the gold if you can. I think this whole thing is as bogus as the attempt to mandate all RNs have BSNs. Nice idea, but practically speaking, will never get off the ground given real world conditions (nursing shortage, shortage of faculty, shortage of dollars to fund nursing education, shortage of financial aid for nursing students, &c.) Unless, MSN programs can give us the option of an actual residency for a few months in addition to the usual required clinical hours, a few extra months of intensive clinical experience, then give us the DNP. That might be worth something, and make it easier to get a job after graduation. Just my 2 cents.

You need to find out which companies staff the area you are interested in traveling to. Try calling the hospitals' staffing offices and ask them if they will share with you which companies they use, then go from there. No one agency staffs everywhere in the country. I think Access works mainly in CA and the southwest. I worked in CA with them. I had a good experience with Access. There were a few glitches here and there, like getting physicals and stuff, but these things can happen anytime with any company. I had good pay, good housing, and great insurance bennies. Were I to travel again I would go with them.

You've made my day. Thank you.

I would like to hear people's comments about being an older NP/CRNA/CNM student. How do faculty, preceptors, and other nurses treat you? Are you respected? Or not? Treated like you're too old to be in the program? Are you asked how old you are? Or are you valued as much as the twenty somethings? How do faculty treat you, as you are in the same peer group (40s - 50s) as most faculty? What do they say about older students? Just curious. I have never heard anyone discuss these issues before and they weigh heavily on me these days.

I have been honored to meet and work with and care for the most amazing people, and the most amazing variety of people, who I would never have known otherwise. I have learned so much from coworkers and patients and their families over the years. If I had not worked in health care I would never have had this opportunity.

On the positive side, I see doulas in many places. Many more nurses are aware of labor support techniques. There is more awareness of breastfeeding. Hospitals finally got rid of those stupid gowns they'd have family members wear in L&D ... Cable TV started those pregnancy and birth shows, which have caused more problems than they are worth, IMHO. Except for House of Babies, with Shari Daniels and the midwives at the Miami birth center -- they show normal unmedicated births and teach the audience something new each episode.

??? "Turtling" is associated with shoulder dystocia. It's the first sign of a problem. The anterior shoulder can't get past the symphysis pubis, so the head retracts. You may be referring to applying counterpressure to the baby's head to slow down a fast explusion, to help prevent tears. You can apply gentle, even pressure over the emerging vertex to keep it from popping out, if baby is coming really fast. You are not trying to change the direction of expulsion of the head as with Ritgen or flexion, you are just trying to slow it down a bit. There are controversial maneuvers that some believe prevent lacerations, but research shows they do not do these things and it's best to let nature take its course. There is a technique of flexion, applying downward pressure over the vertex, to prevent periurethral lacs, but this is controversial. Studies show that modified Ritgens and flexion create more problems than they purport to solve. The diameter of fetal skull that emerges in a normally flexed position is the smallest possible diameter. The woman's body, and the baby, know what they are doing :) There are many research articles on these topics.

You'll get over it.

Excuse me, you think nursing prereqs -- basic sciences and liberal arts -- are "mickey mouse" courses? There are other threads here about this very question, and not very long ago. Google is your friend. The gist of the threads are: no, you can't be a travel nurse until you know what you are doing and can do the job independently. You have to be able to hit the ground running, which can be difficult enough for any experienced nurse who is in a new facility.